What is Lyme Disease?

According to Public Health England, around 3,000 people in the UK are diagnosed with Lyme disease each year. This works out at eight people being infected each day. However, many GPs believe this is an underestimate. A 2019 study found that there are estimated to be as many as 9,000 cases each year.

What’s more, there seems to have been a huge increase in the number of cases in the last two decades. According to the World Health Organization, it is the most common and fastest spreading vector-borne disease in Europe and has been increasing by 14% each year. So, what is Lyme disease and how is it treated?

What is Lyme disease?

Lyme disease, also called Lyme borreliosis due to being caused by Borrelia bacteria, is a vector-borne disease that spreads by ticks. A vector-borne disease is one caused by a living agent carrying and transmitting a pathogen to another living thing. In the case of Lyme disease, the disease vector is the tick.

Lyme disease in humans is transmitted by ticks that are infected with the bacteria that causes the disease. The disease isn’t transmissible between people, through food, or by other animals. This disease is the Northern Hemisphere’s most common disease spread by ticks. Infections mostly occur during spring and through early summer.

Though the disease has existed for a while, it was only first diagnosed of its own accord in 1975. This was in Lyme in Connecticut; hence the disease being named Lyme disease.

Before being recognised as a disease in its own right, it was often diagnosed (mistakenly) as juvenile rheumatoid arthritis.

Research into human vaccines for Lyme disease is ongoing, though there are already preventative vaccines for dogs.

What causes Lyme disease?

Lyme disease is caused by a spiral-shaped bacteria from the Borrelia genus. There are eight known species of this bacteria that are known to cause humans to get Lyme disease. The disease is classed as a zoonotic disease, which means it is transmitted from an animal to a human – in this case, ticks.

Ticks have three stages in their life cycle: the larva stage, the nymph stage, and the adult stage. Most Lyme disease infections occur with a tick in the nymph stage. This is because the ticks are small at this stage and they will go undetected and feed for longer. The ticks in the nymphal stage can be as small as a poppy seed.

Tick bites can also go unnoticed because ticks secrete substances that prevent pain and itchiness. However, it is estimated that only 1.2–1.4% of tick bites result in Lyme disease.

What are the signs and symptoms of Lyme disease?

Depending on the infection stage, untreated Lyme disease will have symptoms that are wide-ranging. These include arthritis, facial paralysis, rash and fever.

Early Lyme disease signs and symptoms

Between 3 and 30 days after a tick bite, a person might have the following signs and symptoms:

• Chills, headache, fever, joint and muscle aches, fatigue, swollen lymph nodes.
• EM rash (erythema rash) – This occurs in between 70% and 80% of cases. It will start at the bite site after three or so days. The average onset of the rash is 7 days after the tick bite but it can be between 3 and 30.
• The rash will expand outwards gradually and might reach as far as 30 centimetres across.
• Though it is unlikely to be painful or itchy, it might feel warm.
• The rash could look like a bull’s eye as it often clears in the middle as it grows. It can also appear anywhere on the body and might not even look like a classic erythema migrans rash at all.

Later symptoms

Days or months after a tick bite, you might have the following symptoms:

• Neck stiffness.
• Severe headache.
• Rashes on other parts of the body.
• Facial palsy (a droop or loss of muscle tone on the face).
• Arthritis that comes with severe swelling and joint pain. It is more likely on the knees or other big joints.
• Pain in muscles, joints, bones and tendons intermittently.
• An irregular heartbeat called Lyme carditis, or heart palpitations.
• Dizziness or shortness of breath.
• Spinal cord or brain inflammation.
• Nerve pain.
• Tingling, numbness, or shooting pains in the feet or hands.

What are the risk factors for Lyme disease?

Anyone can get Lyme disease but it is more likely in some than others. People who work in the outdoors are much more likely to get the disease. Examples of jobs might include landscaping, forestry, surveying, gardening and utilities. It’s also more likely if you do lots of outdoor activities. Examples include hunting, camping and hiking.

Ticks carrying Lyme disease are more prevalent in wet, wooded green areas. They’re not as likely in well-pruned gardens, for example.

The disease tends to be more common in young children aged between 5 and 9. This is because they are exposed more due to playing outside, for example. It is also most common in adults between the ages of 55 and 69. This is likely down to hobbies of walking and hiking.

You’re also more likely to get the disease if you have pets and live in a rural area.

Having exposed skin means you’re also more at risk. If you’re walking in wooded areas, wearing long trousers and long sleeves will give you added protection – as will keeping pets on a lead and not allowing them to wander in long grass.

Another risk factor for Lyme disease is not removing a tick properly or promptly when you spot it. If you spot and remove a tick within two days of being bitten, you’ll have a low risk of getting Lyme disease.

How genetics play a part

Lyme disease itself isn’t genetic but you can inherit genes that determine if you’ll have severe symptoms or not were you to get Lyme disease – It’s all down to how your body is designed to create an autoimmune reaction.

The biggest risk – not knowing you have it

Arguably the biggest risk factor when it comes to Lyme disease and persistent symptoms is the lack of diagnosis and treatment.

If there isn’t a recognised diagnosis, treatment will be lacking.

Risk factors aside, there are things you can do to prevent contracting Lyme disease.

Can Lyme disease be prevented?

Unlike for dogs, there is no human vaccine available that prevents Lyme disease. The only certain way to prevent the disease is by being aware of it and its risk factors. Whenever you go anywhere where ticks are likely to be found, you should use precautionary measures.

Here are some things that might help prevent being bitten by a tick:

• Wear long trousers to prevent ticks from being able to bite.
• Keep an eye on pets and children and keep them away from possible tick sites.
• Avoid wooden areas and tall grass.
• Use an insect repellent.
• Don’t assume you can’t get it again. If you’ve had Lyme disease once, you can still get it again.

Check for ticks and tick bites

As well as preventing tick bites, it’s a good idea to check for bites whenever you’ve been in possible tick sites. You should check yourself and your children for ticks whenever you’ve been spending time outside. Showering after being outdoors is also a good idea.

Ticks prefer areas that are moist and warm and so might migrate to areas that are moist and warm.

For example:

• The groin.
• The scalp/hair.
• The armpits.
• The backs of the knees.
• Inside the navel.
• Around the waist.
• Around or inside the ears.

What do ticks look like?

Ticks are arachnids and have eight legs. They’re small and can be as big as an eraser but as small as a pinhead. Ticks vary in colour. They can be brown, black and even reddish-brown. A tick will grow as it drinks more blood and it can get to marble-size. It might feed for several days if not caught and, if so, it will swell up and become blue-green in colour.

How do you know if you’ve been bitten by a tick?

Ticks will stay on your body to draw blood. When they’ve had enough blood, they’ll drop off. It might stay there for up to 10 days. The longer a tick is on your body, the easier it will be to spot.

Not all tick bites are harmful. The ones that are harmless will cause almost no symptoms or physical signs. You might have a little discolouration or a red bump like a mosquito bite.

With a tick bite and Lyme disease, you’ll usually get a bullseye rash between 3 and 30 days of the bite.

If you do see a tick or a potential tick bite, you should know what to do straight away.

How to remove a tick

Removing a tick is important. You should use tweezers to grasp it near to its mouth or head but don’t crush or squeeze it. Instead, pull steadily or carefully. After removing the tick, it should be disposed of either down the toilet or in alcohol. After removal, it’s important to apply antiseptic.

What happens if Lyme disease is left untreated?

It’s worth knowing that only a small number of tick bites actually lead to Lyme disease. You’re unlikely to get Lyme disease if a tick is attached to you for less than 48 hours. The longer it’s on you, the greater your risk will be.

Early treatment for Lyme disease is important as it will be more effective when it is started as early as possible.

Untreated Lyme disease can cause more symptoms than just a rash on your skin. It can affect your whole body years after the initial infection and can cause problems with the nervous system and arthritis.

One of the biggest complications of the disease is chronic joint inflammation, which particularly affects the knee. You might also experience neurological symptoms like neuropathy or facial palsy as well as cognitive defects like impaired memory. Your heart rhythm can also be irregular.

How is Lyme disease diagnosed?

Lyme disease is not easy to diagnose.

Doctors can make a diagnosis by taking a medical history, which includes an account of tick exposure and symptoms. There isn’t always a rash and the symptoms of Lyme disease can be similar to other medical conditions.

However, there are two different blood tests that will confirm whether or not someone has the condition. These aren’t always accurate in the first stages of the disease so a negative initial result doesn’t necessarily mean Lyme disease isn’t present.

If a doctor still suspects Lyme disease after negative tests, they will reorder the tests further down the line.

How is Lyme disease treated?

Typically, you’ll be prescribed antibiotics when Lyme disease is suspected. The symptoms will determine what antibiotics you’re given and how long you’re given them. Some people might be prescribed a course of antibiotics that lasts four weeks. No matter the course length, it’s important to finish them even if the symptoms disappear.

In severe cases, a GP will refer the patient to a specialist. Usually, they will be given intravenous antibiotics in hospital.

Most people who are treated with antibiotics will get better, though full recovery can take months. If symptoms do persist, specialists can help with further treatments.

Some people who are treated for Lyme disease will continue to experience symptoms like aches, tiredness and a lack of energy. These symptoms sometimes last for years.

Many people compare these symptoms to chronic fatigue syndrome (CFS), which is also known as myalgic encephalomyelitis (ME). No one knows why it affects some people in this way and not others. A doctor might be able to offer support and refer patients for a care needs assessment, if necessary. Even talking therapies like CBT might be useful for patients in this situation.

Final thoughts on ‘What is Lyme disease?’

For a disease that hasn’t long been discovered, it can be quite alarming to look at the statistics. Realistically, though, getting bitten by a tick is still pretty rare and getting Lyme disease from a tick bite is also rare too. The most important thing is to be wary of ticks and where they are then knowing what to look out for after potentially being around them.